This patient has had an achy red right eye for three days. She denies blurred vision. There are no systemic complaints. The likely diagnosis is?
Incorrect. Episcleritis causes a focal engorgement of conjunctival vessels, rather than the accentuated circumcorneal hyperemia of conjunctival and episcleral vessels (“ciliary flush”) you see here. An abnormality of the pupil is a hint toward the correct diagnosis.
Incorrect. Scleritis can cause either focal or diffuse engorgement of conjunctival and episcleral vessels, but not in the circumcorneal pattern (“ciliary flush”) you see here. It is the misshapen pupil that should give you the hint of the correct answer.
Incorrect. Keratitis can also present with the circumcorneal hyperemia (“ciliary flush”) you see here. However, blurred vision, foreign body sensation, and focal corneal surface haziness would be expected. The pupil abnormality suggests another answer choice.
Correct. Uveitis, an autoimmune inflammation of the eye’s uveal tract, can principally affect the iris and ciliary muscle (“anterior uveitis”), the pars plana (“intermediate uveitis”), or the choroid (“posterior uveitis”). Anterior uveitis, the kind you see here, presents with aching pain and photophobia, often sparing vision. Circumcorneal accentuation of conjunctival vascular engorgement (“ciliary flush”) is common. Slit lamp examination will show cells in the anterior chamber. When the slit lamp light beam is aimed across the anterior chamber, it will appear excessively turbid, a sign of excess protein leakage (“flare”). Inflammation in the anterior chamber sometimes leads to adhesions between the iris and anterior lens capsule (“posterior synechiae”) that distort the pupil, as you see here. This condition must be treated promptly and vigorously with topical corticosteroid (and a cycloplegic agent) to prevent permanent damage.